Brain Imaging Findings in Elderly Adults and Years of Life, Healthy Life, and Able Life over the Ensuing 16 Years: The Cardiovascular Health Study

ObjectivesTo determine whether elderly people with different patterns of magnetic resonance imaging (MRI) findings have different long-term outcomes. DesignLongitudinal cohort study. SettingCardiovascular Health Study. ParticipantsIndividuals aged 65 and older were recruited (N=5,888); 3,660 of these underwent MRI, and 3,230 without a stroke before MRI were included in these analyses. MeasurementsCluster analysis of brain MRI findings was previously used to define five clusters: normal, atrophy, simple infract, leukoaraiosis, and complex infarct. Participants were subsequently classified as healthy if they rated their health as excellent, very good, or good and as able if they did not report any limitations in activities of daily living (ADLs). Mean years of life (YoL), years of healthy life (YHL), and years of able life (YAL) were calculated over 16years after the MRI and compared between clusters using unadjusted and adjusted regression analyses. ResultsMean age of participants was 75.0. With 16years of follow-up, mean YoL was 11.3; YHL, 8.0; and YAL, 8.4. Outcomes differed significantly between clusters. With or without adjustments, outcomes were all significantly better in the normal than complex infarct cluster. The three remaining clusters had intermediate results, significantly different from the normal and complex infarct clusters but not usually from one another. Over 16years of follow-up, participants in the complex infarct cluster (n=368) spent the largest percentage of their 8.4years alive being sick (38%) and not able (38%). ConclusionFindings on MRI scans in elderly adults are associated not only with long-term survival, but also with long-term self-rated health and limitation in ADLs. The combination of infarcts and leukoaraiosis carried the worst prognosis, presumably reflecting small vessel disease.